Provider Demographics
NPI:1225668254
Name:HOLLIDAY HILLS MEDICAL MASSAGE AND SPA LLC
Entity Type:Organization
Organization Name:HOLLIDAY HILLS MEDICAL MASSAGE AND SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERPAIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-920-0571
Mailing Address - Street 1:1562 BLUE SKY RD
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-5629
Mailing Address - Country:US
Mailing Address - Phone:208-946-7883
Mailing Address - Fax:
Practice Address - Street 1:6451 MCCALL ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8525
Practice Address - Country:US
Practice Address - Phone:208-920-0571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty